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VUMC Clinic for Transgender Health Opens on August 24

After more than two years of planning, the new Vanderbilt Clinic for Transgender Health will open on Friday, Aug. 24. The clinic, open Friday afternoons to start, will provide comprehensive gender-affirming services in a single convenient location.

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Patients seeking gender affirmation services can contact the Vanderbilt Program for LGBTQ Health for referrals at [email protected] .  

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Vanderbilt to pause gender-affirming procedures for minors

NASHVILLE, Tenn. — Officials at Vanderbilt University Medical Center announced Friday that they are pausing gender-affirming surgeries for minors in order to review their practices.

The news, delivered in a letter sent to a lawmaker who has demanded an end to the surgeries, was publicly released Friday afternoon. It comes amid mounting political pressure from Tennessee’s Republican leaders — many of whom are running for reelection — who called for an investigation into the private nonprofit hospital after  videos surfaced on social media last month  of a doctor touting that gender-affirming procedures are “huge money makers.” Another video showed a staffer saying anyone with a religious objection should quit.

None of the politicians could point to a specific law that the hospital had violated, and no agency to date has committed to an investigation. Republican Gov. Bill Lee’s office said they had passed their concerns to the Attorney General Jonathan Skrmetti, but his office has not commented on whether he is looking into the Nashville-based hospital.

“We are pausing gender affirmation surgeries on patients under age 18 while we complete this review, which may take several months,” wrote C. Wright Pinson, VUMC’s deputy CEO and chief health system officer.

The GOP-dominated Legislature is scheduled to reconvene in January, and many lawmakers have vowed to introduce legislation further limit gender-affirming treatments. If successful, it’s unclear if VUMC would be allowed to resume gender-affirming surgeries for minors, regardless of their internal review.

“We should not allow permanent, life-altering decisions that hurt children,” Lee tweeted late Friday. “With the partnership of the General Assembly, this practice should end in Tennessee.”

According to Pinson, the World Professional Association for Transgender Health recently changed its recommendations for transgender treatment, which helped prompt the need for a review.

On average, VUMC has provided five gender affirming surgeries to minors every year since its transgender clinic opened in 2018. All were over the age of 16 and had parental consent, and none received genital procedures.

“The revenues from this limited number of surgeries represent an immaterial percentage of VUMC’s net operating revenue,” Pinson wrote.

Emails provided to The Associated Press through a public records request show hundreds of Tennesseans reached out to the governor’s office in support of shutting down VUMC’s transgender youth health clinic, with some asking him to call a special legislative session to address the issue. Others asked if he could suspend the licenses of the doctors who work at the clinic.

A few criticized Lee for not taking harsher steps earlier when he signed legislation banning doctors from providing gender-confirming hormone treatment to prepubescent minors.

Only a handful defended the clinic’s services, with some saying the transgender health care they received had been life-saving.

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Vanderbilt hospital agrees to pause gender-affirming surgery on minors, officials say

NASHVILLE, Tenn. (WSMV) - Vanderbilt University Medical Center has agreed to pause gender-affirming surgery on transgender youth following backlash from conservative commentators and politicians, according to state leaders.

“VUMC has agreed to pause gender transition surgeries on minors, as well as honor religious objectors,” State Representative Jason Zachary tweeted Friday afternoon.

“We are so pleased to hear that VUMC has made the right decision and has paused all surgeries for adolescents at their Pediatric Transgender Clinic,” Senator Marsha Blackburn added.

This decision to pause the surgeries comes after Vanderbilt University Medical Center came under fire on social media and in the political arena after a conservative commentator made disputed claims regarding its transgender health clinic.

Matt Walsh, a columnist with the Daily Wire, tweeted last month the clinic “chemically castrates minors,” as well as other claims hospital administrators said are false.

“(VUMC) is now the subject of social media posts and a video that misrepresent facts about the care the Medical Center provides to transgender patients,” a VUMC statement said last month. “VUMC began its Transgender Health Clinic because transgender individuals are a high-risk population for mental and physical health issues and have been consistently underserved by the U.S. health system.”

VUMC said it requires parental consent to treat a minor patient who is to be seen for issues related to transgender care and “never refuses parental involvement in the care of transgender youth who are under age 18,” according to the statement.

In a letter regarding their decision to pause the surgeries, VUMC said since 2018, an average of five minors per years have received gender-affirming surgical procedures, but none of them had “genital procedures.” All minors had parental consent and were at least 16 years old, VUMC said.

Last month, Gov. Bill Lee said the transgender health clinic needed to be investigated.

“The ‘pediatric transgender clinic’ at Vanderbilt University Medical Center raises serious moral, ethical and legal concerns,” Lee said in the statement. “We should not allow permanent, life-altering decisions that hurt children or policies that suppress religious liberties, all for the purpose of financial gain. We have to protect Tennessee children, and this warrants a thorough investigation.”

This is a developing story. Read the full letter below.

Please see Vanderbilt Medical’s response to the @tnhousegop . VUMC has agreed to pause gender transition surgeries on minors as well as honor religious objectors. https://t.co/xXlbSaAOMS pic.twitter.com/4G8laJfQfY — Rep. Jason Zachary (@JasonZacharyTN) October 7, 2022

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Vanderbilt University Medical Center has been and will continue to be committed to providing family-centered care to all adolescents in compliance with state law and in line with professional practice standards and guidance established by medical specialty societies. 

Vanderbilt University Medical Center is now the subject of social media posts and a video that misrepresent facts about the care the Medical Center provides to transgender patients.

VUMC began its Transgender Health Clinic because transgender individuals are a high-risk population for mental and physical health issues and have been consistently underserved by the U.S. health system.

We have been and will continue to be committed to providing family-centered care to all adolescents in compliance with state law and in line with professional practice standards and guidance established by medical specialty societies.

VUMC requires parental consent to treat a minor patient who is to be seen for issues related to transgender care, and never refuses parental involvement in the care of transgender youth who are under age 18.

Our policies allow employees to decline to participate in care they find morally objectionable, and do not permit discrimination against employees who choose to do so.  This includes employees whose personal or religious beliefs do not support gender-affirming care for transgender persons.

The Trans Buddy program mentioned in the video has received national acclaim. Its purpose is to provide peer volunteers who support persons who are seeking highly personal care in an unfamiliar environment, and who may have been refused medical services in the past or avoided seeking them out of fear of being met with hostility.

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Vanderbilt's transgender health clinic pauses gender-affirming surgery for minors amid GOP pressure

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Amid intense pressure from Republicans, the Vanderbilt University Medical Center's transgender clinic has decided to suspend all gender-affirming surgeries for minors.

Dr. C. Wright Pinson, an executive at the Nashville, Tennessee, health center, sent a letter to Republican lawmakers in the state confirming they would be "pausing" gender-affirming procedures in order to "review recommendations."

In a statement sent to CNN , Vanderbilt confirmed the letter was real, but would not elaborate on the new policy.

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Gender-affirming surgeries are defined by the Cleveland Clinic as "procedures that help people transition to their self-identified gender," and Vanderbilt's decision comes despite a large majority of the medical community, including the American Medical Association , concluding that gender-affirming surgeries are safe, effective, and can help children with gender dysmorphia.

The decision to halt gender-affirming surgeries comes under a wave of criticism over the procedures, mostly from Republican politicians in GOP-led states such as Tennessee. The push for Vanderbilt to change its policy was led by Tennessee Gov. Bill Lee (R), who told The Tennessean that the university's clinic raised "serious moral, ethical, and legal concerns," and added that their practices should be investigated.

As part of the anti-gender-affirming push, the state legislature also passed a 2021 law banning hormone therapy for children.

Vanderbilt's decision was heavily criticized by the medical and legal community, including the AMA and the ACLU . The latter said in a statement, "Parents, patients, and medical professionals, not politicians, should decide what medical care is in the best interest of any particular young person."

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 Justin Klawans has worked as a staff writer at The Week since 2022. He began his career covering local news before joining Newsweek as a breaking news reporter, where he wrote about politics, national and global affairs, business, crime, sports, film, television and other Hollywood news. Justin has also freelanced for outlets including Collider and United Press International.  

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Watch CBS News

Vanderbilt University Medical Center to pause gender-affirming surgeries for minors to review practices

October 10, 2022 / 11:32 AM EDT / CBS/AP

Officials at Vanderbilt University Medical Center announced Friday that they are pausing gender-affirming surgeries for minors in order to review their practices.

The news, delivered in a letter sent to a lawmaker who has demanded an end to the surgeries, was publicly released Friday afternoon. It comes amid mounting political pressure from Tennessee's Republican leaders — many of whom are running for reelection — who called for an investigation into the private nonprofit hospital after videos surfaced on social media last month of a doctor touting that gender-affirming procedures are "huge money makers." Another video showed a staffer saying anyone with a religious objection should quit.

None of the politicians could point to a specific law that the hospital had violated, and no agency to date has committed to an investigation. Republican Gov. Bill Lee's office said they had passed their concerns to the Attorney General Jonathan Skrmetti, but his office has not commented on whether he is looking into the Nashville-based hospital.

"We are pausing gender affirmation surgeries on patients under age 18 while we complete this review, which may take several months," wrote C. Wright Pinson, VUMC's deputy CEO and chief health system officer.

The GOP-dominated Legislature is scheduled to reconvene in January, and many lawmakers have vowed to introduce legislation further limit gender-affirming treatments. If successful, it's unclear if VUMC would be allowed to resume gender-affirming surgeries for minors, regardless of their internal review.

"We should not allow permanent, life-altering decisions that hurt children," Lee tweeted late Friday . "With the partnership of the General Assembly, this practice should end in Tennessee."

According to Pinson, the World Professional Association for Transgender Health recently changed its recommendations for transgender treatment, which helped prompt the need for a review. 

The American Academy of Pediatrics  recommends  "providing youth with access to comprehensive gender-affirming and developmentally appropriate health care." In a 2018 policy statement , the AAP also notes that the "supportive involvement of parents and family is associated with better mental and physical health outcomes."

On average, VUMC has provided five gender-affirming surgeries to minors every year since its transgender clinic opened in 2018. All were over the age of 16 and had parental consent, and none received genital procedures.

"The revenues from this limited number of surgeries represent an immaterial percentage of VUMC's net operating revenue," Pinson wrote.

Emails provided to The Associated Press through a public records request show hundreds of Tennesseans reached out to the governor's office in support of shutting down VUMC's transgender youth health clinic, with some asking him to call a special legislative session to address the issue. Others asked if he could suspend the licenses of the doctors who work at the clinic.

A few criticized Lee for not taking harsher steps earlier when he signed legislation banning doctors from providing gender-confirming hormone treatment to prepubescent minors.

Only a handful defended the clinic's services, with some saying the transgender health care they received had been life-saving.

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Vanderbilt pauses gender affirmation surgeries on minors, says genital surgeries not performed

By: anita wadhwani - october 7, 2022 4:07 pm.

Vanderbilt University Medical Center. (Photo: John Partipilo)

Vanderbilt University Medical Center is temporarily halting gender affirming surgeries on patients under the age of 18 while it reviews new national recommendations on the treatment of transgender patients, the hospital’s deputy CEO and chief health system officer said in a letter to Tennessee Rep. Jason Zachary on Friday.

Until now, the hospital’s Transgender Health Clinic had performed an annual average of five surgeries on minors who were at least 16 years old — none were genital procedures, the letter from Deputy CEO and Chief Health System Officer Dr. C. Wright Pinson said.

Pinson’s letter served as a response to demands last week from Zachary and 61 other members of the House Republican Caucus that medical center immediately halt permanent gender affirmation surgeries on minors. The lawmakers said they were “alarmed” by reports from far-right publication the Daily Wire that the clinic was performing “surgical mutilations” on minors.

“It is an egregious error of judgement that an institution as highly respected as Vanderbilt would condone (and promote) harmful and irreversible procedures for minor children in the name of profit,” the Sept. 28 letter sent by the Republicans said . The letter demanded a response from Vanderbilt within 10 days.

The Daily Wire’s Matt Walsh first posted edited video clips last month of Vanderbilt staff discussing transgender surgery: one depicts a physician calling it a “big money maker,” although she does not mention minors; in another, a Vanderbilt plastic surgeon discussed “top surgeries” on 16- and 17-year- old patients who have been on testosterone and have parental permission. Another clip showed a Vanderbilt professor of law saying “conscientious objections” to gender affirming surgery were “problematic.”

Tennessee’s Republican leaders quickly expressed outrage, pledging to introduce legislation prohibiting gender affirming surgery for minors. Gov. Bill Lee said the claims warranted a “full investigation.”

Democrats pushed back, saying that “hate” was being used “for political purposes.”

“Parents should be able to make decisions in regard to their children’s health. That is something Republicans claim to fight for, but refuse to acknowledge when it comes to transition-related care,” Rep. Vincent Dixie, House Democratic Caucus Chair said.

Vanderbilt has been tight-lipped since the controversy emerged. Hospital officials simply noted the healthcare provided to transgender kids is “in compliance with state law and in line with professional proactive standards and guidance established by medical speciality societies,” but declined to answer specific questions.

The clinic’s website, which included photos and contact information for staff at the clinic, was immediately taken down.  STAT News reported that at least 20 children’s hospitals across the nation have been singled out by right-wing pundits and all but three modified or removed website information, in part to protect staff and doctors from threats.

Similar social media campaigns regarding transgender care for minors have led to threats of violence against staff and doctors. Earlier this week, the American Academy of Pediatrics, American Medical Association and Children’s Hospital Association, writing on behalf of 220 children’s hospitals, urged Attorney General Merrick Garland to “investigate the organizations, individuals, and entities coordinating, provoking, and carrying out bomb threats and threats of personal violence against children’s hospitals and physicians across the U.S.”

On Friday, a VUMC spokesperson referred questions from the Lookout to Zachary’s Tweet of Pinson’s letter.

Please see Vanderbilt Medical’s response to the @tnhousegop . VUMC has agreed to pause gender transition surgeries on minors as well as honor religious objectors. https://t.co/xXlbSaAOMS pic.twitter.com/4G8laJfQfY — Rep. Jason Zachary (@JasonZacharyTN) October 7, 2022

The letter notes that Vanderbilt established its Transgender Health Clinic in 2018 “because transgender individuals are at high risk for mental and physical health issues, and have been consistently underserved by our nation’s healthcare systems.”

Pinson’s letter did not specify how many minors have been treated at the clinic, but notes that only a small number of surgeries are performed each year on minors — and all on adolescents at least 16 years of age. None of the surgeries were performed without parental consent, and no surgery involved genital procedures, the letter said.

Revenues from those surgeries constitute “an immaterial percentage of VUMC’s net operating revenue,” the letter said. Pinson noted that VUMC’s policies allow employees to be excluded from medical care they believe is morally objectionable.

Vanderbilt nevertheless is halting such surgeries while it reviews new recommendations from WPATH, the World Professional Association for Transgender Health, issued Sept. 6, the letter said.

“We are pausing gender affirmation surgeries on patients under 18 while we complete this review, which may take several months,” the letter said.

The pause may become indefinite. Pinson acknowledged GOP lawmakers have plans to introduce legislation regarding transgender care, which could be taken up as soon as the Legislature reconvenes in January.

“As always, we will assure that VUMC’s programs comply with any new requirements which may be established as part of Tennessee law,” Pinson said

Our stories may be republished online or in print under Creative Commons license CC BY-NC-ND 4.0. We ask that you edit only for style or to shorten, provide proper attribution and link to our website. AP and Getty images may not be republished. Please see our republishing guidelines for use of any other photos and graphics.

Anita Wadhwani

Anita Wadhwani is a senior reporter for the Tennessee Lookout. The Tennessee AP Broadcasters and Media (TAPME) named her Journalist of the Year in 2019 as well as giving her the Malcolm Law Award for Investigative Journalism. Wadhwani is formerly an investigative reporter with The Tennessean who focused on the impact of public policies on the people and places across Tennessee.

Tennessee Lookout is part of States Newsroom , the nation’s largest state-focused nonprofit news organization.

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Vanderbilt's pediatric transgender care clinic is one of several under assault

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Some clinics paused gender-affirming surgeries for minors due to pushback from critics. Conservative activists say they want to protect kids. Parents of teen patients say the care is saving lives.

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Vanderbilt was never doing genital surgeries on minors but agrees to ‘pause’ other gender-affirming procedures

October 7, 2022

Vanderbilt University Medical Center has agreed to pause gender-affirming surgeries performed by its pediatric transgender health clinic, which has been under fire from Republican lawmakers. Vanderbilt has now responded to a letter signed by 62 GOP members of the Tennessee House of Representatives who demanded the clinic stop surgeries on minors.

Since its founding in 2018, the clinic was doing about five surgeries a year and never on genitals, according to the one-page letter signed by deputy CEO Wright Pinson.

“None of these surgeries have been paid for by state or federal funds,” Pinson says, adding a response to video clips in which a Vanderbilt doctor says there is money to be made in gender-affirming care. “The revenues from this limited number of surgeries represent an immaterial percentage of VUMC’s net operating revenue.”

The clinical guidelines set internationally do allow for breast removal after age 16. Vanderbilt says everyone who has had surgery was at least that old. Clinical guidelines recommend waiting for adulthood on genital surgery, and Vanderbilt says it follows those guidelines.

Vanderbilt’s pause, even on the few surgeries a year, is not permanent. The clinic’s leaders say they will review new clinical guidelines with national experts for several months. But Vanderbilt also agrees to follow whatever laws the state legislature decides to pass.

The concerns expressed by Republicans were first raised by anti-trans activist Matt Walsh. The medical center is also commenting on video clips Walsh posted in which a physician says she has a problem with employees backing out of gender affirming care because of moral objections.

“Comments from videos posted on social media that are obtained at these kind of events should not be construed as statements of VUMC policy,” Pinson says.

Those who want to be excused from care they find morally objectionable are allowed to opt out, according to medical center policy.

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Vanderbilt Hospital Under Civil Rights Investigation Over Releasing Transgender Patient Records To Tennessee AG

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Vanderbilt University Medical Center is under investigation from the Department of Health and Human Services after it provided medical records of patients to Tennessee’s Republican attorney general, the hospital told Forbes —the latest escalation in a saga that has placed the hospital into the middle of the state’s culture war over transgender health care.

Vanderbilt University Medical Center in Nashville, Tennessee is pictured on July 16, 2013. (AP ... [+] Photo/Mark Humphrey, File)

VUMC spokesperson John Howser told Forbes via email “we have been contacted by and are working with the Office of Civil Rights,” but declined to comment further as it is an ongoing investigation.

The news comes after the hospital turned over records on more than 100 patients from its transgender clinic and elsewhere in the hospital to Tennessee Attorney General Jonathan Skrmetti’s office in June as part of a medical billing fraud investigation, a move that sparked privacy concerns amid a political environment increasingly hostile toward the transgender community.

Additionally, the medical records of state workers, the adult children and spouses of state workers and patients of the state’s Medicaid program TennCare—some of whom weren’t patients at transgender clinic—were also shared, the Associated Press reported .

It also comes two weeks after the hospital was sued by two of those 100 patients who allege that VUMC should have removed any personally identifying information from the records before they were turned over, especially because it knew Tennessee officials were hostile toward transgender people, the Associated Press reported .

Key Background

VUMC’s pediatric transgender clinic was forced to suspend operations after a law banning gender-affirming care for minors passed in the Tennessee state legislature was signed by Republican Gov. Bill Lee in March. The clinic first found itself at the center of a divisive debate over transgender care in September 2022, when videos surfaced of VUMC doctors allegedly touting transgender surgeries as “huge money makers” and telling any employees with a religious objection to providing transgender care that they should quit. When it was operating, the transgender clinic offered surgery to an average of five minors per year, none of whom received genital procedures—and all of whom were at least 16 years old and had parental consent—the hospital has said. After the release of these videos, right-wing figures like Matt Walsh, the controversial conservative internet personality who originally published the videos, leveled sharp attacks against the hospital. In response to the videos and conservative backlash, Skrmetti said his office planned to investigate VUMC.

The debate over transgender care in the U.S. has become an increasingly vitriolic issue in American politics. Tennessee is among 19 states that have passed bans or restrictions on transgender health care in 2023 alone, according to a list compiled by Forbes —others being Louisiana, North Carolina, Missouri, Texas, Nebraska, Florida, Oklahoma, Montana, North Dakota, Indiana, Idaho, West Virginia, Kentucky, Georgia, Iowa, Mississippi, South Dakota and Utah. That’s in addition to three other states—Alabama, Arizona and Arkansas—that passed such legislation in 2021 and 2022. This type of legislation has become a rallying cry for the GOP, which has become increasingly hostile to transgender health care, despite consensus from most major medical associations that the care is beneficial and necessary.

Further Reading

Tennessee hospital faces civil rights investigation over release of transgender health records (The Associated Press)

Vanderbilt Hospital Turns Over Transgender Clinic Records To GOP Attorney General In Investigation (Forbes)

Louisiana Restricts Gender-Affirming Care After Overriding Veto—Here Are All The States With Similar Bans Or Restrictions (Forbes)

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Vanderbilt’s Decision to Turn Over Trans Patient Records to the State Sparks Backlash

V anderbilt University Medical Center (VUMC) confirmed Tuesday that it turned over transgender patients’ medical records to the Tennessee attorney general as part of an investigation into medical billing—a move that stirred controversy and privacy concerns.

VUMC offers transgender-related health care for adults and minors in Tennessee and nearby states, where these services are increasingly limited amid polarizing debates and legal clashes over transgender issues across the U.S. Families whose underage children received gender-affirming care at the center felt particularly violated over the record sharing.

The scope of how many patients were affected and details about the investigation remain unclear, but the VUMC said it involved patients enrolled in TennCare insurance plans and that it was asked to submit medical records dating back to 2018, according to screenshots circulating from patients who received notice that they’d been affected.

“The Tennessee Attorney General has legal authority in an investigation to require that VUMC provide complete copies of patient medical records that are relevant to its investigation,” John Howser, VUMC’s chief communications officer, told TIME in a statement. “VUMC was obligated to comply and did so.”

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Much of the backlash on social media against VUMC this week expressed outrage over patient privacy and HIPAA rights, but under federal and state statutes, the medical center is legally required to comply with the attorney general’s investigation and hand over patient records.

“Do we believe that Vanderbilt Medical Center could have fought this and taken a bigger stand? Absolutely. But at the same time, we believe that it would have just prolonged the inevitable because the attorney general unfortunately, has the law on his side,” Lance Preston, executive director of the Rainbow Youth Project, a nonprofit that advocates for LQBTQIA+ young people, says.

Preston worries that months from now, the investigation might halt, but the attorney general’s office would still have a comprehensive list of transgender patients—an idea that’s sparking fear, particularly among transgender youth.

Growing fears

Following the news this week, Tennessee Attorney General Jonathan Skrmetti’s chief of staff, Brandon Smith said, “We are surprised that VUMC has deliberately chosen to frighten its patients like this.” Smith said the attorney general had been investigating potential billing fraud since September and that VUMC began providing patient records in December. Smith emphasized that the investigation was directed toward VUMC and related providers, not patients.

Preston says between June 20 and June 21, Rainbow Youth Project’s crisis received hundreds of calls from both young people and parents that were frightened over the turning over of VUMC’s transgender patient records.

Callers were in varying degrees of mental health crisis over the news, including intense fear and suicidal ideation, Preston said. “Even though the numbers are high , and it’s hard for us to handle that call volume, we would much rather see them reaching out than not,” Preston says.

Rainbow Youth Project had a similar spike in calls last spring after Texas Governor Greg Abbott instructed child welfare agents to investigate child abuse among parents who provided their children gender-affirming care, a move that was later blocked. “People don’t understand that whether a new bill passes or it gets vetoed, just to talk about it creates fear and crisis,” Preston says.

Gender-affirming care uses medical procedures like hormone therapy and surgery to help a person transition from their assigned gender at birth to the one they identify as. Access to gender-affirming health care, especially for minors, is somewhat limited throughout the South following a myriad of restrictions over the past year.

Nashville, where VUMC is located, is a hub in the region for transgender-related health care. Neighboring states, Arkansas and Kentucky, each currently have under a dozen transgender-affirming providers, according to the Campaign for Southern Equality, a nonprofit.

VUMC said it started its Transgender Health Clinic in 2018 to address the heightened risk of mental and physical illness that transgender people face. Prominent medical associations, such as the American Medical Association , have researched and supported gender-affirming care for minors.

Last fall, right-wing political commentator Matt Walsh made a series of social media posts condemning VUMC’s gender-affirming surgeries for minors and hosted a “Rally to End Child Mutilation” in Nashville. VUMC stated that it followed standards of care set by the World Professional Association of Transgender Health, but after pressure from Republican lawmakers in September, urging the medical center to cease gender-affirming surgeries on minors, VUMC decided to halt all such surgeries temporarily.

VUMC noted that gender-affirming surgeries for minors have been rare at the center, at an average of five per year, and only with patients aged 16 and up.

In February, the Tennessee legislature overwhelmingly passed Senate Bill 1, banning gender transition health care for minors, beginning July 1. The Justice Department filed a complaint in late April challenging the bill, but it has yet to move forward.

Cultural impact

Over the past year, just like the medical center, Vanderbilt University has been embroiled in controversy surrounding transgender issues.

The Vanderbilt College Republicans, a student organization, hosted a debate on campus in early April over whether it should be legal for minors to receive gender-affirming care. The debate was preceded by a protest and several other student groups criticized the event, arguing that it was offensive and told transgender students that their existence was up for debate.

Induja Kumar, a junior at Vanderbilt studying political science and climate studies, advocates for the university administration to do more to protect queer and transgender students. “You can find so many anonymous op-eds by trans students on campus,” she says, but publicly, “people are really afraid to speak out.” She says she’s witnessed peers who are vocal about being transgender or queer get doxed and harassed on the internet. Kumar worries that speaking with TIME could have similar consequences for her, but persists to vocalize her concerns.

“What happens when medical records are turned over to the attorney general in the next investigation?” Kumar says, anxious about future privacy breaches against transgender students as well as patients receiving reproductive health services. Abortion is extremely limited in Tennessee. “How many students are at risk of having their medical privacy violated, and then being criminalized because of that?” Kumar adds.

Preston notes that 77 teens who called Rainbow Youth Project over anxiety about the VUMC medical record dissemination reported that they didn’t want to receive or continue counseling in Tennessee. “They’re afraid if they go to mental health counseling, and they reveal their gender identity or sexual orientation, that’s going to lead to their records being turned over or their families being investigated,” Paxton says.

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Gender Confirmation Surgery (GCS)

What is Gender Confirmation Surgery?

• Transfeminine Tr

Transmasculine Transition

• Traveling Abroad

Choosing a Surgeon

Gender confirmation surgery (GCS), known clinically as genitoplasty, are procedures that surgically confirm a person's gender by altering the genitalia and other physical features to align with their desired physical characteristics. Gender confirmation surgeries are also called gender affirmation procedures. These are both respectful terms.

Gender dysphoria , an experience of misalignment between gender and sex, is becoming more widely diagnosed.  People diagnosed with gender dysphoria are often referred to as "transgender," though one does not necessarily need to experience gender dysphoria to be a member of the transgender community. It is important to note there is controversy around the gender dysphoria diagnosis. Many disapprove of it, noting that the diagnosis suggests that being transgender is an illness.

Ellen Lindner / Verywell

Transfeminine Transition

Transfeminine is a term inclusive of trans women and non-binary trans people assigned male at birth.

Gender confirmation procedures that a transfeminine person may undergo include:

• Penectomy is the surgical removal of external male genitalia.
• Orchiectomy is the surgical removal of the testes.
• Vaginoplasty is the surgical creation of a vagina.
• Feminizing genitoplasty creates internal female genitalia.
• Breast implants create breasts.
• Gluteoplasty increases buttock volume.
• Chondrolaryngoplasty is a procedure on the throat that can minimize the appearance of Adam's apple .

Feminizing hormones are commonly used for at least 12 months prior to breast augmentation to maximize breast growth and achieve a better surgical outcome. They are also often used for approximately 12 months prior to feminizing genital surgeries.

Facial feminization surgery (FFS) is often done to soften the lines of the face. FFS can include softening the brow line, rhinoplasty (nose job), smoothing the jaw and forehead, and altering the cheekbones. Each person is unique and the procedures that are done are based on the individual's need and budget,

Transmasculine is a term inclusive of trans men and non-binary trans people assigned female at birth.

Gender confirmation procedures that a transmasculine person may undergo include:

• Masculinizing genitoplasty is the surgical creation of external genitalia. This procedure uses the tissue of the labia to create a penis.
• Phalloplasty is the surgical construction of a penis using a skin graft from the forearm, thigh, or upper back.
• Metoidioplasty is the creation of a penis from the hormonally enlarged clitoris.
• Scrotoplasty is the creation of a scrotum.

Procedures that change the genitalia are performed with other procedures, which may be extensive.

The change to a masculine appearance may also include hormone therapy with testosterone, a mastectomy (surgical removal of the breasts), hysterectomy (surgical removal of the uterus), and perhaps additional cosmetic procedures intended to masculinize the appearance.

Paying For Gender Confirmation Surgery

Medicare and some health insurance providers in the United States may cover a portion of the cost of gender confirmation surgery.

It is unlawful to discriminate or withhold healthcare based on sex or gender. However, many plans do have exclusions.

For most transgender individuals, the burden of financing the procedure(s) is the main difficulty in obtaining treatment. The cost of transitioning can often exceed $100,000 in the United States, depending upon the procedures needed.

A typical genitoplasty alone averages about $18,000. Rhinoplasty, or a nose job, averaged $5,409 in 2019.  

Traveling Abroad for GCS

Some patients seek gender confirmation surgery overseas, as the procedures can be less expensive in some other countries. It is important to remember that traveling to a foreign country for surgery, also known as surgery tourism, can be very risky.

Regardless of where the surgery will be performed, it is essential that your surgeon is skilled in the procedure being performed and that your surgery will be performed in a reputable facility that offers high-quality care.

When choosing a surgeon , it is important to do your research, whether the surgery is performed in the U.S. or elsewhere. Talk to people who have already had the procedure and ask about their experience and their surgeon.

Before and after photos don't tell the whole story, and can easily be altered, so consider asking for a patient reference with whom you can speak.

It is important to remember that surgeons have specialties and to stick with your surgeon's specialty. For example, you may choose to have one surgeon perform a genitoplasty, but another to perform facial surgeries. This may result in more expenses, but it can result in a better outcome.

A Word From Verywell

Gender confirmation surgery is very complex, and the procedures that one person needs to achieve their desired result can be very different from what another person wants.

Each individual's goals for their appearance will be different. For example, one individual may feel strongly that breast implants are essential to having a desirable and feminine appearance, while a different person may not feel that breast size is a concern. A personalized approach is essential to satisfaction because personal appearance is so highly individualized.

Davy Z, Toze M. What is gender dysphoria? A critical systematic narrative review . Transgend Health . 2018;3(1):159-169. doi:10.1089/trgh.2018.0014

Morrison SD, Vyas KS, Motakef S, et al. Facial Feminization: Systematic Review of the Literature . Plast Reconstr Surg. 2016;137(6):1759-70. doi:10.1097/PRS.0000000000002171

Hadj-moussa M, Agarwal S, Ohl DA, Kuzon WM. Masculinizing Genital Gender Confirmation Surgery . Sex Med Rev . 2019;7(1):141-155. doi:10.1016/j.sxmr.2018.06.004

Dowshen NL, Christensen J, Gruschow SM. Health Insurance Coverage of Recommended Gender-Affirming Health Care Services for Transgender Youth: Shopping Online for Coverage Information . Transgend Health . 2019;4(1):131-135. doi:10.1089/trgh.2018.0055

American Society of Plastic Surgeons. Rhinoplasty nose surgery .

Rights Group: More U.S. Companies Covering Cost of Gender Reassignment Surgery. CNS News. http://cnsnews.com/news/article/rights-group-more-us-companies-covering-cost-gender-reassignment-surgery

The Sex Change Capital of the US. CBS News. http://www.cbsnews.com/2100-3445_162-4423154.html

By Jennifer Whitlock, RN, MSN, FN Jennifer Whitlock, RN, MSN, FNP-C, is a board-certified family nurse practitioner. She has experience in primary care and hospital medicine.